Making Nurses’ Academic Progression a Reality

Sep 30, 2013, 9:00 AM

Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation.

There is near-universal agreement among health care stakeholders and experts that the country needs to grow the number of primary care providers. If the health care system is to meet the growing demand for care that will result from the greying of the Baby Boomers and the influx of millions of newly insured Americans, we're going to need a bigger, better-prepared health care workforce.

That’s a point the 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, made very clearly with respect to nurses. That landmark report also pointed out that health care is becoming increasingly complex as our understanding of illness grows and as the tools and systems we have available to combat it change and evolve.

The latest edition of Charting Nursing's Future, the policy brief series from the Robert Wood Johnson Foundation (RWJF), takes a look at one of several strategies recommended by the IOM for addressing the challenges: Increasing the opportunities for nurses' academic progression. The brief discusses the implications of an aging population and the dramatic increase in Americans with access to care, and addresses nurses' evolving roles:

In addition to possessing a fundamental knowledge of patients’ health needs and the skills and abilities required for entry-level nursing practice, today’s nurses are called upon to take part in and lead interprofessional initiatives aimed at improving the quality, safety, and efficiency of care delivery. Nurses are also in the forefront of care coordination and prevention now that more care is being delivered in the home, the community, and remotely. Baccalaureate degrees, with their inclusion of public and community health content, help equip nurses to meet these challenges.

The brief also makes the case for more nurses with advanced degrees—masters of science in nursing, PhDs, and doctorates of nursing practice (DNP)—in order to grow the ranks of nurse practitioners, nurse scientists, and nursing school faculty, thus expanding the pipeline that transports would-be nurses into the profession.

A number of initiatives around the nation are leading the way in advancing nurses' academic progression, and the brief spotlights several of those efforts.

The New Mexico Nursing Consortium, for example, has developed a common curriculum for use at state nursing schools, thus allowing 100-percent transfer of nursing credits when students move between institutions. The approach makes it easier for community colleges and universities to form partnerships to deliver bachelor of science (BSN) courses at community colleges.

In Massachusetts, the nursing education and practice communities collaborated on a set of "Nurse of the Future Nursing Core Competencies," a guide for nursing education and practice in the state. The method broadens students' focus from learning discrete skills to developing the ability to function as professionals. That, too, helps ease transitions between institutions.

In Florida and 18 other states, community college baccalaureate (CCB) degree programs allow nursing students to earn BSN degrees at nearby community colleges, making degrees more affordable and encouraging diversity. And while the approach has generated some controversy, early data demonstrate that three-quarters of students in Florida CCB programs are over the age of 24, suggesting that the programs do not compete with four-year institutions, whose students are usually much younger.

Another proven approach is the RN-to-MSN degree-completion program, a model that allows nurses with associate degrees or hospital diplomas to earn masters of science in nursing degrees. Over the last 15 years, such programs have doubled in number across the United States, with 173 in operation today, and more in development.

Finally, employer-based incentives are becoming more common. Northwestern Memorial Hospital in Chicago, for example, is working toward a 100-percent BSN-prepared nursing workforce by offering partial tuition reimbursement, scholarship support, and tuition discounts to its nurses who do not yet hold BSNs. Meanwhile, the hospital has adopted a BSN-only hiring policy.

I'm proud to say that RWJF is backing many of these approaches with direct funding, and the Future of Nursing: Campaign for Action, our collaboration with AARP, has engaged Action Coalitions in all 50 states and the District of Columbia to advance nurses' opportunities for academic progression.

The IOM established two targets in this area to be achieved by 2020: first, increasing the share of nurses in the workforce with baccalaureate degrees to 80 percent, and second, doubling the number of nurses with doctoral degrees. That's a significant challenge, by any measure, but the leaders highlighted in this latest Charting Nursing's Future brief are showing us the way forward.